Racial/ethnic differences underlying the illicit use of prescription stimulants (IUPS) were examined. A 2 X 2 (African American/Caucasian and male/female) design with n = 120 per group (mean age of 19.23, SD = 1.30) was used to evaluate survey responses regarding IUPS and their ADHD symptoms (using the Adult ADHD Self-Report Scale; ASRS). First, African Americans endorsed IUPS less frequently (p < .001) and reported lower levels of ADHD symptoms (p < .01). Second, participants rated three domains of risk for IUPS. African Americans perceived higher social risk (p < .001). No significant differences were found for legal or health risks. Third, African Americans perceived lower benefits for IUPS for concentration (p < .001), alertness (p < .001), and help with studying (p < .001). Minor gender differences are discussed and implications for targeting risk/benefit beliefs in IUPS prevention and treatment programs are discussed.

The treatment of impacted third molars that have neither symptoms nor disease is controversial. One school of thought is that these teeth should be extracted before they do become symptomatic and/or diseased. A second school of thought advocates retaining these teeth until such time when they show evidence of developing symptoms or disease. The purpose of this review is to present the reasoning behind the two opposing schools of thought. Studies involving both the risks and the benefits of extracting and retaining asymptomatic, disease-free third molars were examined. There are studies to support the proponents of each school of thought. Proponents of removal are of the belief that many asymptomatic and disease-free impacted third molars eventually do become symptomatic and/or diseased, and do so when the patient is older. The morbidity and incidence of complications common to the procedure increase with age, and therefore proponents of removal prefer that surgery be performed at a younger age when the complications are less likely to be as severe or permanent. Those in support of retaining and monitoring these teeth are of the opinion that the status of these asymptomatic and disease-free impacted third molars may never change and therefore never require surgical intervention. They believe the increased complication rate and morbidity experience by some of the older surgical patients do not justify the routine removal of all asymptomatic, disease-free impacted third molars at an early age. Both groups recognize that when surgical intervention is employed, complications such as pain, swelling, alveolar osteitis, periodontal problems, temporomandibular joint disorders, nerve involvement, sinus communication, and financial stress are not uncommon. Ultimately, the clinician must consider the information presented in this review, and combine it with his/her academic knowledge and personal clinical experience to inform the patient of the risks and benefits of both treatment options. That way, the clinician and the patient together can decide the strategy for management of an asymptomatic, disease-free third molar.

Central to the goals of public health are obtaining and interpreting timely and relevant information for the benefit of humanity. In this dissertation, we propose methods to monitor and assess the spread HIV in a more rapid manner, as well as to improve decisions regarding patient treatment options. In Chapter 1, we propose a method, extending the previously proposed dual-testing algorithm and augmented cross-sectional design, for estimating the HIV incidence rate in a particular community. Compared to existing methods, our proposed estimator allows for shorter follow-up time and does not require estimation of the mean window period, a crucial, but often unknown, parameter. The estimator performs well in a wide range of simulation settings. We discuss when this estimator would be expected to perform well and offer design considerations for the implementation of such a study. Chapters 2 and 3 are concerned with obtaining a more complete understanding of the impact of treatment in randomized clinical trials in which multiple patient outcomes are recorded. Chapter 2 provides an illustration of methods that may be used to address concerns of both risk-benefit analysis and personalized medicine simultaneously, with a goal of successfully identifying patients who will be ideal candidates for future treatment. Riskbenefit analysis is intended to address the multivariate nature of patient outcomes, while “personalized medicine” is concerned with patient heterogeneity, both of which complicate the determination of a treatment’s usefulness. A third complicating factor is the duration of treatment use. Chapter 3 features proposed methods for assessing the impact of treatment as a function of time, as well as methods for summarizing the impact of treatment across a range of follow-up times. Chapter 4 addresses the issue of meta-analysis, a commonly used tool for combining information for multiple independent studies, primarily for the purpose of answering a clinical question not suitably addressed by any one single study. This approach has proven highly useful and attractive in recent years, but often relies on parametric assumptions that cannot be verified. We propose a non-parametric approach to meta-analysis, valid in a wider range of scenarios, minimizing concerns over compromised validity.

Objective: Little is known about the parental perception of usage and delivery of Vaccine Information Statements (VISs), the timing of VIS delivery, parent opportunity to read VISs, and time for discussing content of VISs with providers. Parental reports of dissemination and use of VISs are explored in this study, including parental use, experience, and perceptions. Method: Data for this pilot cross-sectional descriptive study were collected via an online survey. The instrument consisted of 21questions including five demographic questions, 11 questions about VIS distribution, four questions about parental use and understanding of VISs, and one open-ended question about finding information about immunizations (see appendix A). The questionnaire was available in both English and Spanish. Results: Responses from 130 parents in one school district were used for analysis. Most participants (67.7%) reported getting vaccine information from a pediatric healthcare provider. A large majority of participants (71.5%) said VISs were included as part of the vaccination process and that they received a paper copy (64.6%). About a third of participants (37.7%) said they read some or all of the VIS before their child was vaccinated and over half (59.3%) said they read some or all of the VIS after their child was vaccinated. Discussion: While it is promising that many parents reported receiving the federally mandated vaccine information, over a quarter of parents reported they did not receive a VIS. Similar to findings in the literature, a majority of parents read all or part of the VIS after an immunization appointment. Limited time to read and understand the information on the VIS before an immunization was administered may lead to limited parental understanding. Although some parents reported struggling to understand VISs, more than half of the parents in our study said that VISs were helpful and would read another in the future. Nursing Implications: Without appropriate use of VISs and other vaccine education material, providers miss the opportunity to educate parents on the risks and benefits of vaccinating their children. Conclusion: Since their implementation in 1986, there has been little research on VIS use for vaccine education and parental perception. Providers must be aware of literacy levels and vaccine attitudes and create appropriate opportunities for parents to read and learn about vaccines. VISs are a valuable tool to educate patients and parents on the benefits and risks of vaccines. Improvements are needed to improve the clarity of the VIS messaging and dissemination practices.

No description available.

L’objectif de cette thèse était de développer un cadre conceptuel et méthodologique permettant d’évaluer l’impact global de l’alimentation sur la santé des consommateurs, en prenant en compte les dimensions microbiologiques, chimiques et nutritionnelles. Cette méthodologie a été développée à l’aide d’un cas d’étude portant sur l’alimentation des nourrissons (lait maternel et formules infantiles), incluant les facteurs suivants : C. sakazakii, Cryptosporidium, arsenic, polychlorobiphényles de type dioxine et acide docosahexaénoïque. Cinq modèles mathématiques probabilistes ont été développés pour quantifier les risques / bénéfices associés à chaque facteur. Ils ont été ensuite harmonisés, quand cela a été possible, à l’aide d’un indicateur commun de santé publique, le DALY. Les résultats ont été obtenus par simulation de Monte Carlo de second ordre afin de quantifier séparément l’incertitude et la variabilité. Les techniques probabilistes ont permis de prendre en compte d’une part la variabilité inhérente à la biologie (hétérogénéité entre individus d’une même population) et d’autre part l’incertitude liée au manque de connaissances et de données. De plus, la séparation de la variabilité et de l’incertitude a consolidé l’évaluation, permettant une interprétation plus cohérente des résultats et donc fournissant des informations plus complètes aux décisionnaires. La méthode mise en oeuvre dans ce travail de thèse pourra servir de base pour d’autres cas d’études et pourra aussi être utilisée pour continuer le développement méthodologique de l’évaluation risque-bénéfice. Cette démarche s’inscrit dans une approche plus générale d’analyse multi-critères des systèmes agronomiques et alimentaires / The objective of the present PhD project was to develop a conceptual and methodological framework to assess the overall impact of food consumed on human health, including microbiological, chemical and nutritional dimensions. This methodology was developed using a case study on infant milk-based diet (breast milk and infant formulas) taking into account the following selected factors: C. sakazakii, Cryptosporidium, arsenic, dioxin like polychlorinated biphenyls and docosahexaenoic acid. Five probabilistics mathematicals models were developed to quantify risks / benefits associated with these factors. When possible, they were harmonized using a common public health indicator, the DALY. Results were obtained by second-order Monte Carlo simulations in order to quantify separately the uncertainty and the variability. Probabilistic techniques enabled to take into account on the one hand the biology related to variability (heterogeneity between individuals of the same population) and on the other hand the uncertainty linked to the lack of knowledge and data. In addition, separation of variability and uncertainty strengthened the evaluation by enabling a more accurated interpretation of results and by providing more comprehensive information for policy makers. The method used in this PhD thesis can be considered as a robust basis for other case studies and can be also used to continue methodological development in risk-benefit assessment. This approach is also part of a broader area: the multi-criteria decision analysis of agronomic and food systems

L'objectif du travail est de mettre en place des méthodes d'évaluation des risques microbiologiques et des bénéfices nutritionnels lors de la transformation des légumes, en vue d'une analyse risque-bénéfice. Le risque (industriel) considéré est l'altération des conserves de haricots verts due à la bactérie thermophile Geobacillus stearothermophilus, et le bénéfice nutritionnel est la teneur en vitamine C des haricots verts appertisés. Des paramètres de référence ont d'abord été acquis, par une méta-analyse par approche bayésienne pour la partie risque. Les paramètres de résistance thermique D à 121.1°C et pH 7, zT et zpH de G.stearothermophilus ont ainsi été estimés respectivement à 3.3 min, 9.1°C et 4.3 unités pH en moyenne en milieu aqueux. Les modèles risque et bénéfice ont ensuite été analysés par la méthode de simulation de Monte Carlo à deux dimensions, permettant une propagation séparée de la variabilité et de l'incertitude. Les pertes en vitamine C prédites par le modèle entre la matière première et les légumes appertisés sont de 86% en moyenne, et le taux de non-stabilité à 55°C prédit est de 0.5% en moyenne, globalement en accord avec la réalité. Une analyse risque-bénéfice a ensuite visé à optimiser le bénéfice tout en gardant le risque à un niveau acceptable, par exploration de scénarios d'interventions possibles basés sur les résultats d'analyses de sensibilité. Enfin, un modèle d'évaluation des risques dus à la bactérie pathogène Bacillus cereus dans une purée de courgettes a été confronté à des données de contamination dans des produits incubés, par le biais d'une inférence bayésienne. / The aim of this work is to set up microbiological risk and nutritional benefit assessment methods in the transformation of vegetables, in view of a risk-benefit analysis. The considered (industrial) risk is the alteration of green bean cans due to thermophilic bacteria Geobacillus stearothermophilus, and the nutritional benefit is the vitamin C content in appertized green beans. Reference parameters have first been acquired, by a meta-analysis using Bayesian inference for the risk part. Thermal resistance parameters D at 121.1°C and pH 7, zT and zpH of G.stearothermophilus have been respectively estimated at 3.3 min, 9.1°C and 4.3 pH units on average in aqueous media. The risk and benefit models have then been analyzed by a two-dimensional Monte Carlo simulation method, allowing a separated propagation of uncertainty and variability. The vitamin C losses between fresh and appertized green beans predicted by the model are of 86% on average, and the predicted non-stability at 55°C rate is of 0.5% on average, in good accordance with reality. A risk-benefit analysis has then been carried out to optimize benefit while keeping risk at an acceptable level, by exploring possible intervention scenarios based on some sensibility analysis results. Finally, a risk analysis model involving pathogenic bacteria Bacillus cereus in a courgette puree has been confronted to incubated product contamination data, by means of a Bayesian inference.

Tolerable risk Abstract The thesis deals with the topic of tolerable risk. Tolerable risk is a type of criminal defense that has first appeared in the Penal Code, Act No. 40/2009 Coll. Today, after almost ten years since the it came into effect, is the time to summarize the practical use of this institute. Chapter One outlines the types of criminal defenses and looks at the position that tolerable risk takes among them. Chapter Two offers a historical viewon the development of tolerable risk as an institute; first showing how it had been inferred from doctrine and then how the final version of tolerable risk, implemented in the Penal Code, was found. Chapter Three analyses the constructional features of tolerable risk; that means the conditions to be met in order to apply this criminal defense. Chapter Four compares tolerable risk with other criminal defenses, both legally defined (self-defense, necessity, consent, legitimate use of the weapon) and also not legally defined (fulfillment of obligation, exercise of entitlement, performance of a profession). Chapters five, six and sevendeal with the most common areas in which tolerable risk is employed. These areas are healthcare (Chapter Five), economy (Chapter Six) and sport (Chapter Seven).These three chapters focus on those components of tolerable risk that...

Véritable carrefour de problématiques économiques, biologiques, sociologiques, culturelles et sanitaires, l’alimentation suscite de nombreuses polémiques. Dans un contexte où les échanges mondiaux facilitent le transport de denrées alimentaires produites dans des conditions environnementales diverses, où la consommation de masse encourage les stratégies visant à réduire les coûts et maximiser le volume de production (OGM, pesticides, etc.) il devient nécessaire de quantifier les risques sanitaires que de tels procédés engendrent. Notre intérêt se place ici sur l’étude de l’exposition chronique, de l’ordre de l’année, à un ensemble de contaminants dont la nocivité à long terme est d’ores et déjà établie. Les dangers et bénéfices de l’alimentation ne se restreignant pas à l’ingestion ou non de substances toxiques, nous ajoutons à nos objectifs l’étude de certains apports nutritionnels. Nos travaux se centrent ainsi autour de trois axes principaux. Dans un premier temps, nous nous intéressons à l'analyse statistique des très fortes expositions chroniques à une ou plusieurs substances chimiques, en nous basant principalement sur des résultats issus de la théorie des valeurs extrêmes. Nous adaptons ensuite des méthodes d'apprentissage statistique de type ensembles de volume minimum pour l'identification de paniers de consommation réalisant un compromis entre risque toxicologique et bénéfice nutritionnel. Enfin, nous étudions les propriétés asymptotiques d'un certain nombre d'estimateurs permettant d'évaluer les caractéristiques de l'exposition, qui prennent en compte le plan de sondage utilisé pour collecter les données. / At a crossroads of economical, sociological, cultural and sanitary issues, dietary analysis is of major importance for public health institutes. When international trade facilitates the transportation of foodstuffs produced in very different environmental conditions, when conspicuous consumption encourages profitable strategies (GMO, pesticides, etc.), it is necessary to quantify the sanitary risks engendered by such economic behaviors. We are interested in the evaluation of chronic types of exposure (at a yearly scale) to food contaminants, the long-term toxicity of which is already well documented. Because dietary risk and benefit is not limited to the abuse or the avoidance of toxic substances, nutritional intakes are also considered. Our work is thus organized along three main lines of research. We first consider the statistical analysis of very high long-term types of exposure to one or more chemical elements present in the food, adopting approaches in keeping with extreme value theory. Then, we adapt classical techniques borrowed from the statistical learning field concerning minimum volume set estimation in order to identify dietary habits that realize a compromise between toxicological risk and nutritional benefit. Finally, we study the asymptotic properties of a number of statistics that can assess the characteristics of the distribution of individual exposure, which take into account the possible survey scheme from which the data originate.